A recent study found that late-stage cervical cancer is on the rise, particularly among Black women in the Southern United States. The study found that women in the U.S. South of all races were less likely than women in other areas of the U.S. to be vaccinated against human papillomavirus (HPV) or to have been screened for cervical cancer. This is certainly the case in Kentucky where only 57% of adolescents between the ages of 13 and 17 have received the HPV vaccine, reflecting one of the lowest vaccination rates in the country. Meanwhile, Kentucky has one of the highest rates of new cases of cervical cancer with 9.6 cases per 100,000 women annually. Counties in Eastern Kentucky are disproportionately impacted by new cases of cervical cancer and related mortality. Lack of access to insurance, mistrust of the healthcare system, and misconceptions about the safety and efficacy of the HPV vaccine are some of the contributors to racial and geographic disparities in cervical cancer screening and mortality and differential rates of HPV vaccine uptake across the Commonwealth.
HPV is a common sexually transmitted infection and is the cause for 91% of cervical cancers as well as other types of cancers such as penile (60%), cancers of the oropharynx (70%), and vaginal cancers (75%). In 2018, there were 43 million HPV infections in the United States with many of these infections occurring in teens and young adults in their early 20s. HPV is typically symptom-free which means you won’t know if you have it and may unintentionally pass it to others. There is no cure for HPV though it can be prevented through vaccination.
The significance of the HPV vaccine in cancer prevention and the importance of screening for cervical cancer are recognized in the Healthy People 2030 objectives. There are two objectives related to HPV vaccination and one related to cervical cancer screening.
- Increase the proportion of adolescents who get recommended doses of the HPV vaccine.
- Reduce infections of HPV types prevented by the vaccine in young adults.
- Increase the proportion of females who get screened for cervical cancer.
The Advisory Committee on Immunization Practices (ACIP) currently recommends that HPV vaccination begin at age 11 or 12 for both boys and girls. In 2019, ACIP updated their guidance to recommend HPV vaccination for males and females up to age 26, recognizing that infection occurs more frequently in the early 20s. Likewise, the United States Preventive Service Task Force recommends that all women ages 21 to 65 be screened for cervical cancer every three years and that women ages 30 to 65 receive a high-risk HPV test every five years.
In August 2023, KHC will release its most recent Community Measurement Reports for Kentucky and Kentuckiana. These reports are compiled using claims data from six health plans and provide a look into state-wide progress on measures from the Kentucky Core Healthcare Measures Set (KCHMS), 38 primary care measures intended to align measurement efforts toward shared areas of focus. These measures align with the national Healthcare Effectiveness Data and Information Set (HEDIS) which is used by more than 90% of health plans to measure performance and quality of care. Cervical cancer screening and HPV vaccination rates among adolescents are two of the measures that KHC tracks in the Community Measurement reports. The most recent report (2020) of Kentucky’s performance on the KCHMS showed that, among the four health plans for which data was available in 2020, 57% of women received screening for cervical cancer. Among women with Medicaid, 55% received screening for cervical cancer. The rate of HPV vaccination for adolescents was 34%.
The cost of HPV-attributable cancers to payers is immense. One economic analysis found the estimated incremental per-person cost to treat certain types of HPV-attributable cancers ranged from $53,000 to $101,000, depending on the type of cancer. The study found that, for example, the two-year incremental direct medical costs for cervical cancer was $93,272. Overall, the key driver of medical costs related to HPV-attributable cancers was outpatient care. Additionally, the total annual medical cost for cervical cancer care in 2020 was $2.3 billion, which accounted for 1% of all cancer treatment costs in the United States. Increasing the rates of cervical cancer screening will improve rates of early identification and successful treatment, which can prevent deaths and reduce overall costs.
Employers can play a key role in cancer prevention in Kentucky by implementing efforts to increase the rates of cervical cancer screening among their employees. The Affordable Care Act required that most health plans provide preventive care, including cancer screenings, at no out-of-pocket cost to the employee. Yet, the rate of cervical cancer screening remains low in many areas of the country and in Kentucky. Examples of strategies that employers can implement to increase cervical cancer screenings among employees are:
- Understand the gap—surveys or focus groups can be done to better understand why employees are not receiving recommended screenings and identify opportunities to increase access to and use of screenings
- Provide paid time off for cancer screenings
- Educate employees in the recommended age groups about the importance of cervical cancer screening
- Support worksite screenings or other events to increase access to and awareness of screenings
Kentucky has huge potential for growth in each of these areas—both in HPV vaccination rates and cervical cancer screening. The upcoming release of the Community Measurement Reports in summer 2023 will provide an opportunity to reflect on these measures and engage further in strategic discussions to improve HPV vaccination rates in Kentucky and decrease the burden of HPV-attributable cancers.
